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This is VAERS ID 281960

(NOTE: This result is from the 12/8/2009 version of the VAERS database)

Case Details

VAERS ID: 281960 (history)  
Form: Version .0  
Age: 13.0  
Gender: Female  
Location: Mississippi  
   Days after vaccination:4
Submitted: 2007-06-15
   Days after onset:12
Entered: 2007-06-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: Private
Symptoms: Computerised tomogram normal, Convulsion, Drug screen negative, Full blood count normal, Laboratory test normal, Loss of consciousness, Pregnancy test negative, Respiratory arrest, Urinary incontinence, Urine analysis normal
SMQs:, Torsade de pointes/QT prolongation (broad), Anaphylactic reaction (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Acute central respiratory depression (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? Yes
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Concerta 54mg qam
Current Illness: none
Preexisting Conditions: ADHD
Diagnostic Lab Data: CT head negative. CBC, serum chemistries all normal. Urinalysis, urine drug screen, and urine pregnancy test all negative.
CDC Split Type:

Write-up: Patient had presumed seizure activity on 6/3/2007, 4 days after vaccine administration. Patient found unconscious by father -- not breathing and incontinent of urine. Event lasted approximately 2-3 minutes. Patient taken to ER by ambulance.

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